My name is Liz Grice, and I am a Clinical Psychologist.
I qualified in 1993, and I have been working with people with
brain injuries since 1994, when I began sessional work at Headway
East Dorset as part of my work with Dorset HealthCare Trust. I
have also worked with carers, including carers groups both at
East Dorset Headway and Headway Southampton. I am currently the
Manager of Headway Southampton, which provides day care/rehabilitation
and support for those with brain injuries and their carers.

There are a number of points that I want to
raise from my experiences both as a Clinical Psychologist working
with brain injury and as the Manager of Headway Southampton.

1. Older adults

When brain injured adults reach the age of 65,
even though their problems are related to brain injury not ageing,
Social Services remove them from their day provision and place
them in older adults day centres, which are not appropriate. One
of our clients, Mr S, suffered just such a fate, but he and his
wife were not happy with this, so he stopped using day provision
until they found out about us from neighbouring Headway Winchester.

We also have a problem when it comes to funding
for older adults because older adults day centres cost half of
what we do. We have several people over 65 who became brain injured
when they were older, one fell from his bicycle and one was run
over by a fork lift truck. These people are not suitable for older
adults day centres as their problems are related to their brain
injuries. In fact, Mr B, the man run over by the fork lift truck,
was 75 when he was injured and although he looks well, he is our
most difficult client because of the behaviour problems he has
as a result of his brain injury.

2. Physical disability services

Social Services class brain injury in the same
category as physical disability. This means that they tend to
look towards physical disability day centres for their day provision.
Unfortunately, many brain injured people do not have an obvious
physical disability and find it distressing to be placed somewhere
where some people have many physical problems. Conversely those
who are physically disabled but cognitively intact do not understand
why these brain injured people behave the way they do. The staff
in the physical disability day centres do not feel able to handle
some of these brain injured adults because they do not know enough
about brain injury or how to handle challenging behaviours. I
recently conducted a training session with a local physical disability
day centre that they requested because of precisely these problems.

I have discovered that Social Services managers
also do not understand why brain injured people are not best placed
in physical disability and do not understand the difference. This
was in a discussion about funding with Hampshire Social Services.
There is a clear need for brain injury to be a category separate
from physical disability.

3. Social Services charging

The policy of making a charge to those receiving
care from Social Services, depending on their means, is unfortunately
not universal when it comes to brain injury. Hampshire have this
policy, Southampton City do not. This means that we have people
attending the day centre who pay a contribution towards their
attendance and some who do not. This is seen as unfair by those
who have to pay.

4. Lack of understanding by professionals

I am still being told by both those who have
a brain injury and their carers, that medical staff have told
them that if someone is not knocked unconscious then they are
not considered to have a brain injury. Neuropsychological assessment
makes it perfectly plain that this is not the case. Some people
may have an apparently minor injury but still suffer problems
as a result. A lady I saw recently fell and banged the back of
her head on the stair rail. She was told she would be fine in
two weeks. Three months later she is still suffering from extreme
head pain, visual disturbance and fatigue, all of which is preventing
her from working. The problem is now that this is tending to be
viewed as psychological, which I can say with certainty, it is
not.

5. Carers' comments regarding having to fight
for everything

I have now run four carers groups and spoken
to numerous carers since 1994, all of whom make the same kind
of comments about the person they care for not being seen as having
a problem and having to fight with both Social Services and Health
to get the level of care and support needed. This is in addition
to the Benefits Agency and in particular the DLA, which is focused
on physical disability, with no allowance for the disability caused
by cognitive problems. I have personally conducted a number of
neuropsychological assessments to provide evidence for a DLA tribunal.
I have also attended a tribunal in order to explain the nature
of the neuropsychological difficulties being experienced by one
of my clients. Mr E can walk and talk, but is so distractible
that he joins in with conversations of passers by. His memory
is so bad that he does not recall anything that happened the previous
day or even the previous hour. His family have had to have an
extension built with a sound-proofed quiet room, because he cannot
cope with the normal sounds from four boisterous children aged
from 6 to 16. He will never work again and cannot be left alone
because he forgets what he is doing and does not see danger (for
example trying to remove grass from the blades of a lawnmower
whilst it was still running). Even with all these problems, it
was still necessary to appeal to a tribunal because his level
of difficulty was not appreciated from the forms and from the
cursory examination given to him by the doctor who examined him
for the DLA.

6. Social Services handling of clients

I have had a dispute with a local social services
area office. They attempted to persuade two of our clients to
say that they no longer wished to attend. They did this with no
advocate present and did so quite clearly in an attempt to save
money. Apart from the questions it raises about social services
practice, I also discovered that social services do not seem to
be aware that those with brain injuries in some cases need advocates
in the same way as those with learning difficulties because they
forget, they are suggestible and make poor judgements. They may
also have given a relative their power of attorney because they
cannot handle their own affairs.

Conclusion

These are some of the issues which have arisen
with clients that I have personally dealt with. There are other
issues which I do not have time to address here. My opinion is
that brain injury is poorly understood by medical professionals,
social services, the benefits agency and the public at large.
The classifying of brain injury as a separate category is essential
for the effective delivery of services and as a basis for educating
others about the problems of brain injury.